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Ann Thorac Surg 2004;77:2263
© 2004 The Society of Thoracic Surgeons

Correspondence

Use of autologous arterial patches for tracheal reconstruction in young infants: Reply

Emmanuel Martinod, MDa, Jacques F. Azorin, MDa

a Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, 125 Route de Stalingrad, 93000 Bobigny, France

Alain F. Carpentier, MD, PhDb

b Laboratoire d'Etude des Greffes et Prothèses Cardiaques, Hôpital Broussais, UPRES 264, Université Paris 6, 96 Rue Didot 75014 Paris, France

e-mail: emartinod{at}wanadoo.fr

To the Editor:

We thank Drs Hazekamp and Nijdam for their very interesting comments. Facing the unsolved problem of tracheal replacement, we proposed an original solution: the use of an arterial autograft. In successive experiments, we [1–4] demonstrated that the carotid artery could be used as an autologous patch for the repair of limited tracheal defects, that an autologous aortic graft could be a valuable substitute for the trachea after extensive resection, and that a temporary silicone stent is needed for extensive tracheal replacement to avoid collapse of the new airway. We observed a progressive transformation of the arterial graft into tracheal tissue with regeneration of epithelium and cartilage. These histologic changes could explain why the grafts remained functional with a 3-year follow-up.

Dodge-Khatami and colleagues [5] confirmed these results with carotid patch plasty to repair a long-segment congenital tracheal stenosis in a 4-month-old girl. Since then, they have successfully placed a patch from the ascending aorta in 2 additional patients. These experimental and clinical results seem to indicate that the choice of an autologous arterial substitute could be appropriate in children. However, use of a complete circular autologous aortic segment in selected instances must still be evaluated.

For tracheal replacement in adults, the choice of an aortic allograft appears to be more attractive to avoid harvest of an arterial segment. Extensive tracheal replacement with an aortic allograft has be evaluated experimentally before clinical application. This could be a very promising alternative for patients with lesions extending over more than half the length of the trachea.

References

  1. Martinod E., Aupecle B., Zegdi R., et al. Remplacement segmentaire de la trachée par une autogreffe aortique: la "trachée-artère". Presse Med 1999;28:1638.
  2. Martinod E., Zakine G., Fornes P., et al. Metaplasia of aortic tissue into tracheal tissue. Surgical perspectives [in French]. C R Acad Sci III 2000;323:455-460.
  3. Martinod E., Zegdi R., Zakine G., et al. A novel approach to tracheal replacement: the use of an aortic graft. J Thorac Cardiovasc Surg 2001;122:197-198.
  4. Martinod E., Seguin A., Pfeuty K., et al. Long-term evaluation of the replacement of the trachea with an autologous aortic graft. Ann Thorac Surg 2003;75:1572-1578.
  5. Dodge-Khatami A., Nijdam N.C., Broekhuis E., Von Rosenstiel I.A., Dahlem P.G., Hazekamp M.G. Carotid artery patch plasty as a last resort repair for long-segment congenital tracheal stenosis. J Thorac Cardiovasc Surg 2002;123:826-828.




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